Alcoholism: Abstinence Versus Controlled Drinking

An additional concern is that the lack of research supporting the efficacy of established interventions for achieving nonabstinence goals presents a barrier to implementation. A considerable number of clients reported changed views on the programme, some were still abstinent and some were drinking in a controlled way. Some of the abstainers still attended meetings because of a fear of what might happen if they stopped, although they questioned parts of the philosophy. For these clients, the recovery process, aiming to reach sustained recovery in the broader sense covering parts of their lives other than the SUD, was in part at odds with the ongoing participation in AA.

Alcoholism: Abstinence Versus Controlled Drinking

Thus, this is interesting to analyse further although the younger IPs in this article, with experience of 12-step treatment, are too few to allow for a separate analysis. However, they will be included in a further analysis on young adults based on the same premises as in present article but with experience from other treatments than the 12-step treatment. Some strategies and guidelines to consider if you’re aiming to practice controlled drinking include setting limits, eating before drinking, choosing drinks with lower alcohol content, alternatives with non-alcoholic beverages and having abstinent days. Relapse Prevention (RP) is another well-studied model used in both AUD and DUD treatment (Marlatt & Gordon, 1985).

Controversy in the Recovery Community

• Cultural perspectives on alcohol also influence our attitudes towards its use and misuse, shaping norms around what constitutes acceptable levels of consumption.
• A recent qualitative study found that concern about missing substances was significantly correlated with not completing treatment (Zemore, Ware, Gilbert, & Pinedo, 2021).
• At Addictionhelper, we will never tell you “you can’t ever drink again” because that is not our place.
• The present study indicates that the strict views in AA also might prevent clients in AA to seek help and support elsewhere, since they percieve that this conflicts with the AA philosophy (Klingemann and Klingemann, 2017).

Studies which have interviewed participants and staff of SUD treatment centers have cited ambivalence about abstinence as among the top reasons for premature treatment termination (Ball, Carroll, Canning-Ball, & Rounsaville, 2006; Palmer, Murphy, Piselli, & Ball, 2009; Wagner, Acier, & Dietlin, 2018). One study found that among those who did not complete an abstinence-based (12-Step) SUD treatment program, ongoing/relapse to substance use was the most frequently-endorsed reason for leaving treatment early (Laudet, Stanick, & Sands, 2009). A recent qualitative study found that concern about missing substances was significantly correlated with not completing treatment (Zemore, Ware, Gilbert, & Pinedo, 2021). Unfortunately, few quantitative, survey-based studies have included substance use during treatment as a potential reason for treatment noncompletion, representing a significant gap in this body of literature (for a review, see Brorson, Ajo Arnevik, Rand-Hendriksen, & Duckert, 2013). Additionally, no studies identified in this review compared reasons for not completing treatment between abstinence-focused and nonabstinence treatment. In addition to shaping mainstream addiction treatment, the abstinence-only 12-Step model also had an indelible effect on the field of SUD treatment research.

The Moderation Management Program

In this model, treatment success is defined as achieving and sustaining total abstinence from alcohol and drugs, and readiness for treatment is conflated with commitment to abstinence (e.g., Harrell, Trenz, Scherer, Martins, & Latimer, 2013). Additionally, the system is punitive to those who do not achieve abstinence, as exemplified by the widespread practice of involuntary treatment discharge for those who return to use (White, Scott, Dennis, & Boyle, 2005). Rather, when people with SUD are surveyed about reasons they are not in treatment, not being ready to stop using substances is consistently the top reason cited, even among individuals who perceive a need for treatment (SAMHSA, 2018, 2019a). Even among those who do perceive a need for treatment, less than half (40%) make any effort to get it (SAMHSA, 2019a).

The concept behind harm reduction is meeting the client where they are in terms of their commitment and motivation to change. Abstinence is a very overwhelming concept for individuals, which can often push them away from seeking or continuing treatment. Therefore, this approach allows the client and their treatment team to come up with a specific plan that allows them to use their substance of choice in a moderate and safe way. Unlike treatment clinics that generally prescribe naltrexone or nalmefene to be taken on a daily basis, The Sinclair Method asks patients to take the medication 1-2 hours before consuming alcohol on any day that alcohol will be consumed. On any day alcohol is not consumed, no medication needs to be taken; thereby,allowing the patient to enjoy a natural release of endorphins from activities and life events.

Before a person can successfully begin their recovery, a vital question to ask is what is my goal? If the answer is a few now and then, the next question to ask is am I honestly able to do that? The majority of people I ask this question to will say no, it is never one or two, Drug rehabilitation it always leads onto more.

In contrast, individuals with greater SUD severity, who are more likely to have abstinence goals, generally have the best outcomes when working toward abstinence (Witkiewitz, 2008). Together, this suggests a promising degree of alignment between goal selection and probability of success, and it highlights the potential utility of nonabstinence treatment as an “early intervention” approach to prevent SUD escalation. This paper presents a narrative review of the literature and a call for increased research attention on the development of empirically supported nonabstinence treatments for SUD to engage and treat more people with SUD. We define nonabstinence treatments as those without an explicit goal of abstinence from psychoactive substance use, including treatment aimed at achieving moderation, reductions in use, and/or reductions in substance-related harms. We first provide an overview of the development of abstinence and nonabstinence approaches within the historical context of SUD treatment in the U.S., followed by an evaluation of literature underlying the theoretical and empirical rationale for nonabstinence treatment approaches. Lastly, we review existing models of nonabstinence psychosocial treatment for SUD among adults, with a special focus on interventions for drug use, to identify gaps in the literature and directions for future research.

According to advocates of The Sinclair Method, drinking is a learned behaviour, and one example of conditioning. Although conditioning is useful for survival, this mechanism can also reinforce behavior and habits which are detrimental to the health of the individual, including alcohol dependence (as well as additional anti-social behavior). The Sinclair Method is a treatment for alcohol dependency designed to implement a pavlovian technique called pharmacological extinction. This includes the use of an opiate block such as naltrexone which turns habit-forming behaviours into those which are habit erasing. The outcome is to reduce the urge to want to drink; thereby, returning the patient to a pre-heavy drinking state of mind.

A common objection to CD is that most people fail to return to “normal” drinking, and highlighting those able to drink in a controlled way might attract people into relapse, with severe medical and social consequences. On the other hand, previous research has reported that a major reason for not seeking treatment among alcohol-dependent people is the perceived requirement of abstinence (Keyes et al., 2010; Wallhed Finn et al., 2014, 2018). In turn, stigma and shame have been reported as a reason for not seeking treatment (Probst et al., 2015).